Background
Osteonecrosis of Jaw (ONJ) after Bisphosphonate (BP) treatment has large variability as clinical history and outcome. Even if a negative impact on Quality of Life has been described and demonstrated, ONJ is usually described as an event with mild or moderate sereneness. However, as a form of osteomyelitis with potential severe complications, ONJ can rarely be life-threatening.
Material and methods
We reviewed the ONJ literature (PubMed and other sources) looking for severe complications and/or lethal or life-threatening ONJ cases. We also reviewed history of 44 ONJ cases observed by our hospital ONJ multidisciplinary team.
Results
We analyzed 36 papers potentially referring to severe cases of ONJ history (not related to surgery complications), not only in cancer patients receiving iv BPs but also in patients with osteoporosis and non-malignant diseases receiving oral BPs (Mehanna 2010, Ebker 2013). In our experience, 2 cases out of 44 (4.5%) had history of hospital admission due to severe infections related to ONJ. Case 1. A male patient, 65 years old, affected by Renal Cell Cancer and bone metastases, was admitted at the Intensive Unit of another hospital due to large neck infection with cellulitis. History revealed he had been treated with zoledronic acid and sunitinib. CT scan showed large mandible lesions compatible with an undiagnosed ONJ. The patient responded to antibiotic therapy and was homed some weeks. In the following 2 years, he showed ONJ in 3 quadrants. Case 2. A female breast cancer patient, 80 years old, was submitted on 2005 to several teeth extractions, after 5.5 years of monthly IV pamidronate treatment. She developed mandible skin fistulae and received numerous courses of antibiotic therapy; in one case she needed hospitalization to receive large spectrum IV antibiotics and blood transfusions.
Discussion
Some ONJ patients (immunocompromised; treated with antiangiogenic agents; with comorbidity; elderly) can be at risk of life-threatening events correlated to ONJ.
References
- Ebker T, Rech J, Von Wilmowsky C, et al. Fulminant course of osteonecrosis of the jaw in a rheumatoid arthritis patient following oral bisphosphonate intake and biologic therapy. Rheumatology (Oxford) 2013 Jan;52(1):218–20. doi: 10.1093/rheumatology/kes351. [DOI] [PubMed] [Google Scholar]
- Kaehling C, Streckbein P, Schmermund D, et al. Lethal cervical abscess following bisphosphonate related osteonecrosis of the jaw. J Craniomaxillofac Surg. 2014 Feb 27; doi: 10.1016/j.jcms.2014.02.009. [DOI] [PubMed] [Google Scholar]
- Mehanna P, Goddard R. Bisphosphonate associated Osteonecrosis: an unusual case. Aust Dent J. 2010 Sep;55(3):311–3. doi: 10.1111/j.1834-7819.2010.01240.x. [DOI] [PubMed] [Google Scholar]